Introduction OSA is associated with increased risk of complications in surgical patients, as anaesthetic and analgesic agents reduce upper respiratory muscle function1. While polygraphy is diagnostic, increased waiting times can delay surgery. Validated screening tools helps stratifying high-risk patients, prioritise referrals and enable early initiation of pre-operative CPAP.
The Sleep Team and anaesthetics team at WWL have set up a standardised pathway in November 2022 for patient with clinical suspicion of OSA to reduce risk of delay to surgery and streamline referrals (figure 1).
Methods Demographics of patients, types of surgery; STOP-BANG score, apnoea-hypopnea index (AHI); Epworth Sleepiness Score (ESS), mean waiting time from referral to study were recorded.
Data was collected from pre-op referrals during January-March 2019 and between January-March 2023.
Results Before pathway,
5 patients referred,60% male & 40% female, mean age 64 yo
60% awaiting orthopaedic surgery, 1 gastrointestinal surgery; 1 gastroscopy
AHI-normal (n=2), mild (n=1) and severe (n=2); mean AHI 29.8 (95% CI, 2.1, 57.5)
STOP-BANG scores were completed in 60%, mean of 5.6
Mean ESS was 4.8 (1 missing data), 40% treated with CPAP
The mean waiting time from referral to study was 56 days.
11 referred, 7 male, 4 female; mean age 66 yo
7 orthopaedic surgery, 3 hernia repair & 1 minor operation
AHI-mild (n=2), moderate (n=5) and severe (n=3); mean AHI of 20.7 (95% CI 12.4, 29.0)
STOP-BANG scores were completed in 100%, mean score of 5.2
Mean ESS was 5.45 (100% data), 54% treated with CPAP
The mean waiting time has improved to 19.9 days
Discussions There is reduction in sleep study waiting times after the introduction of pathway and improvement of referral information which allow access to early treatment and improve safety for high-risk group.
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